Gastric rupture caused by acute gastric distention in non-neonatal children: clinical analysis of 3 cases

Objective To study gastric rupture, a progressive, rapid and high mortality condition, cau sed by acute gastric distention (GRAGD) and its appropriate diagnosis and treatment. Methods The etiology, pathology, clinical manifestations and experiences in 3 children w ith GRAGD were reviewed. Results Case 1: After diagnosising GRAGD and stabilizing her shock with massive fluid re placement, gastrostomy was performed. Her postoperative course was uneventful b ecause of fasting, sucti on, fluid infusion, correction of acidosis and supporting nutrition. Case 2: A fter diagnosising gastric distention which subsided with conservative therapy fo r 9 days, she suddenly had gastric rupture when she had not eaten for 6 days. She died of shock and had no chance for surgery. Case 3: The patient had sudden abdominal pain, distention and vomitting with severe shock for 4 days. Emergen cy surgery found gastric rupture and the method was the same as Case 1. The pat ient survived but has brain impairment. Case 1 and 3 showed multifocal transmur al necrosis. Conclusions Symptoms like overeating, bulimia, changes in kind of food, X-ray showing large distended stomach and massive pneumoperitoneum were seen after gastric ruptur e and can help to diagnose this condition. Clinical course of gastric distentio n with toxic shock progresses rapidly, however subsequent gastric rupture exacer bates the shock and makes the treatment difficult treatment. It is extremely im portant that a laparotomy be performed at once after stabilizing shock with mass ive fluid replacement. Postoperative nutritional support and fluid replacement will increase survival. It is very important that when gastric distention disap pears after conservative therapy, the doctor should assess carefully whether the gastric wall recovery is under way by using effective methods of examination.